BACKGROUND: In colorectal cancer, the involvement of regional lymph nodes with metastasis is an established prognostic factor. The impact of the number of positive nodes on patient outcome with stage IV disease is not well defined. METHODS: A retrospective review was performed of 1,421 patients at two tertiary referral centers with stage IV colorectal cancer who underwent primary tumor resection. Associations between regional nodes, lymph node ratio (LNR), and overall survival (OS) from date of diagnosis were analyzed. RESULTS: The number of positive regional nodes and LNR correlated with multiple sites of metastases (p < 0.001). Survival was significantly associated with the number of positive nodes and LNR, with a median OS of 43 months with negative nodes, compared to 20 months with ≥7 positive nodes (p < 0.001). The number of regional nodal metastases correlated with OS among 400 patients undergoing resection of liver metastases (p = 0.005) but lost prognostic significance in the subset of 223 patients who underwent hepatectomy with perioperative oxaliplatin- or irinotecan-based chemotherapy (p = 0.48). CONCLUSIONS: In stage IV colorectal cancer, an increasing number of positive regional nodes and LNR correlate with multiple sites of metastases and poorer survival. The number of metastatic regional lymph nodes loses prognostic significance with modern chemotherapy in patients undergoing resection of liver metastases.
BACKGROUND: In colorectal cancer, the involvement of regional lymph nodes with metastasis is an established prognostic factor. The impact of the number of positive nodes on patient outcome with stage IV disease is not well defined. METHODS: A retrospective review was performed of 1,421 patients at two tertiary referral centers with stage IV colorectal cancer who underwent primary tumor resection. Associations between regional nodes, lymph node ratio (LNR), and overall survival (OS) from date of diagnosis were analyzed. RESULTS: The number of positive regional nodes and LNR correlated with multiple sites of metastases (p < 0.001). Survival was significantly associated with the number of positive nodes and LNR, with a median OS of 43 months with negative nodes, compared to 20 months with ≥7 positive nodes (p < 0.001). The number of regional nodal metastases correlated with OS among 400 patients undergoing resection of liver metastases (p = 0.005) but lost prognostic significance in the subset of 223 patients who underwent hepatectomy with perioperative oxaliplatin- or irinotecan-based chemotherapy (p = 0.48). CONCLUSIONS: In stage IV colorectal cancer, an increasing number of positive regional nodes and LNR correlate with multiple sites of metastases and poorer survival. The number of metastatic regional lymph nodes loses prognostic significance with modern chemotherapy in patients undergoing resection of liver metastases.
Authors: Scott Kopetz; George J Chang; Michael J Overman; Cathy Eng; Daniel J Sargent; David W Larson; Axel Grothey; Jean-Nicolas Vauthey; David M Nagorney; Robert R McWilliams Journal: J Clin Oncol Date: 2009-05-26 Impact factor: 44.544
Authors: Peter Kornprat; William R Jarnagin; Mithat Gonen; Ronald P DeMatteo; Yuman Fong; Leslie H Blumgart; Michael D'Angelica Journal: Ann Surg Oncol Date: 2006-12-31 Impact factor: 5.344
Authors: Wilson I Gonsalves; Joseph Wolpert; Tsewang Tashi; Apar K Ganti; Shanmuga Subbiah; Charles Ternent; Peter T Silberstein Journal: J Surg Oncol Date: 2012-03-27 Impact factor: 3.454
Authors: Adam C Berger; Elin R Sigurdson; Thomas LeVoyer; Alexandra Hanlon; Robert J Mayer; John S Macdonald; Paul J Catalano; Daniel G Haller Journal: J Clin Oncol Date: 2005-12-01 Impact factor: 44.544
Authors: Nakul P Valsangkar; Devon M Bush; James S Michaelson; Cristina R Ferrone; Jennifer A Wargo; Keith D Lillemoe; Carlos Fernández-del Castillo; Andrew L Warshaw; Sarah P Thayer Journal: J Gastrointest Surg Date: 2012-12-11 Impact factor: 3.452
Authors: Kenneth Cardona; Pedro Mastrodomenico; Francesco D'Amico; Jinru Shia; Mithat Gönen; Martin R Weiser; Philip B Paty; T Peter Kingham; Peter J Allen; Ronald P De Matteo; Yuman Fong; William R Jarnagin; Michael I D'Angelica Journal: Ann Surg Oncol Date: 2012-07-31 Impact factor: 5.344
Authors: Michael W Kattan; Mithat Gönen; William R Jarnagin; Ronald DeMatteo; Michael D'Angelica; Martin Weiser; Leslie H Blumgart; Yuman Fong Journal: Ann Surg Date: 2008-02 Impact factor: 12.969
Authors: Shaheen Zakaria; John H Donohue; Florencia G Que; Michael B Farnell; Cathy D Schleck; Duane M Ilstrup; David M Nagorney Journal: Ann Surg Date: 2007-08 Impact factor: 12.969
Authors: Dan G Blazer; Yoji Kishi; Dipen M Maru; Scott Kopetz; Yun Shin Chun; Michael J Overman; David Fogelman; Cathy Eng; David Z Chang; Huamin Wang; Daria Zorzi; Dario Ribero; Lee M Ellis; Katrina Y Glover; Robert A Wolff; Steven A Curley; Eddie K Abdalla; Jean-Nicolas Vauthey Journal: J Clin Oncol Date: 2008-10-20 Impact factor: 44.544
Authors: Jan Bednarsch; Zoltan Czigany; Samara Sharmeen; Gregory van der Kroft; Pavel Strnad; Tom Florian Ulmer; Peter Isfort; Philipp Bruners; Georg Lurje; Ulf Peter Neumann Journal: World J Surg Oncol Date: 2020-06-24 Impact factor: 2.754